Overdose deaths drive down U.S. life expectancy

Tom Corwin @aug_scimed

Thursday

Nov 29, 2018 at 12:30 AM

A surge in overdose deaths in 2017 actually drove down the overall U.S. life expectancy last year. An addiction expert says the problem is inadequate resources for treatment, stigma and other barriers to seeking help, and powerful drugs.

Dr. William Jacobs offers a sad smile when told that overdose deaths last year helped drive down overall U.S life expectancy for 2017.

"This is not new news to me," said Jacobs, chief of addiction medicine at Medical College of Georgia and medical director of Bluff Plantation addiction treatment center. "I hear this every day. I see it in the patients I treat."

A surge of more than 70,000 drug overdose deaths, as well as an uptick in suicide, helped decrease overall U.S. life expectancy from 78.7 years in 2016 to 78.6 in 2017, according to statistics released today from the National Center for Health Statistics.

The drug overdose death rate increased 9.6 percent, from 19.8 per 100,000 to 21.7 per 100,000, the report found. There were 58 overdose deaths in Augusta in 2017, Richmond County Coroner Mark Bowen said.

"Those drugs are running rampant," he said. Georgia had 1,537 overdoses last year, according to the report.

The rate of overdose deaths due to synthetic opioids like fentanyl increased 45 percent between 2016 and 2017, according to the national report. While fentanyl is a concern, which is roughly 100 times more powerful than morphine, its analogues are even more dangerous, Jacobs said. The Georgia Bureau of Investigation has identified about 20 so far, including carfentanil, which is 10,000 times more powerful than morphine. In fact, a fatal amount of carfentanil for someone who had no tolerance to the drugs could be as little as 20 micrograms, Jacobs said.

"To put that in context, a snowflake weighs 30 micrograms," he said. "So we’re talking about 2/3rds of the weight of a snowflake will kill a non-tolerant person." The drug prompted the U.S. Drug Enforcement Agency to issue a warning a couple of years ago for first responders and lab personnel about accidental exposure to it.

Some people also die after getting clean, either through treatment or a stay in jail or prison, and then relapsing after their tolerance to the drugs has been lowered.

"Their previous usual amount, because they had tolerance, will now kill them," Jacobs said. "We see it all the time. And we actually caution patients about that."

It's one reason his program puts patients on opiate-blockers such as naltrexone to help prevent relapse.

"We also encourage patients and their families, even if we think they have a strong recovery, to still have Narcan (naloxone) on hand in case they slip and need resuscitation," Jacobs said.

One of the biggest hurdles to addressing these deaths and the opioid crisis overall is the lack of treatment available.

"Only about one out of 10 patients who needs it gets treatment, of any kind," Jacobs said. "And the only ones who get into treatment are the ones who have hit a major crisis. They’ve had an overdose, or two or three. Something really bad has happened."

Addiction treatment centers can also be misleading, he said, presenting a 28-day program as a cure.

"That’s something you have to work on with patients and families," Jacobs said. "This is a chronic illness. We are not curing you. We can put the disease in remission and it can be held in remission with a strong maintenance program."

Insurers can also be difficult, he said. Oftentimes, the insurer will only authorize a 4-5 day stay at an inpatient program, and the staff has to fight for additional days at every stage, to where the average length of stay ends up at around 24 days, which is not adequate for the amount of healing needed, Jacobs said.

In fact, addiction is a chronic disease like any other, such as diabetes or asthma, but it is not treated that way by providers, or insurers or the public at large, he said. Much more education is needed, not only among providers but in society in general to address the unnecessary stigma attached to those with the disease, Jacobs said.

"You find out one of you neighbors has cancer, everyone shows up with a casserole," he said. "You find out your next door neighbor’s kid has been admitted to addiction treatment, nobody even wants to look at him. We’ve got to continue to work on addressing the stereotype."

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